Birth Control & Pregnancy

Choosing The Right Contraceptive Method

Choosing the right contraceptive method(s) for you and your partner depends on many factors.

Here are some things to consider when choosing a method of contraception:

• Use: Will you remember to take a medication (at the same time every day)? Do you know how to use a barrier method? Will you be able to use this method (correctly) every time? Do you understand the instructions for this and other methods? Do you know what happens if you forget to use it? Are you willing to use a backup method?
• Effectiveness: How well does it prevent pregnancy? What can impact the effectiveness of each method? Would using a backup method make you more comfortable with the effectiveness?
• Side effects: What happens if you stop a medication? What should you expect when you start a new one? Are you willing to watch out for and deal with the side effects and risks (especially important for hormonal methods, with mood changes and weight gain)?
• Cost: Does it require a prescription? Doctor visits? Will you have access to this method in the future? Can it be purchased by both partners?

Contraceptive options include:

• Barrier methods: Condoms, diaphragms, the contraceptive sponge and cervical caps
• Hormonal methods: Birth control pills (BCPs; also called oral contraceptives (OCs), Long-acting hormonal methods (shots, Mirena and implants), Hormonal contraceptive patch or vaginal ring
• Behavioral methods: Abstinence, Natural family planning, Withdrawal
• Other options: Intrauterine devices (IUDs), Emergency contraception, Sterilization/Vasectomy, Spermicides

Pregnancy options include:

• Abortion
• Adoption
• Raising a child

Contraceptive Technology offers a side by side comparison of various forms of contraception.

Understanding Effectiveness

When looking at the effectiveness rating of a birth control option, it is important to remember how effectiveness is measured and what the effectiveness means.

Effectiveness is the average rate of success for sexually active couples using this method for one year. For example, with typical use, male condoms are about 85% effective. This means that for a large sample of couples using exclusively male condoms for one year, about 85% of them did not get pregnant (15% of the couples sampled did get pregnant).

So, the failure rate for each individual time using a condom is much lower, while the lifelong effectiveness rate compounds failure rates for every year.

Effectiveness is often divided into “perfect use” and “typical use”.

• Perfect use is a measure of effectiveness when the method of birth control is used correctly every time (ie. Taking the pill at exactly the same time each morning, always leaving space at the tip of condoms applied with lube) and for every instance of intercourse.
• Typical use is a measure of the effectiveness of the method as it is generally used, with some error in use and application. Typical use accounts for mistakes on the part of those providing instructions on how to use the method, mistakes on the part of the method’s users, conscious non-compliance, and impeded access to the method.

Barrier Methods

Condoms (Male & Female)

USE: There are multiple kinds of condoms – male condoms, female condoms, lubricated or un-lubricated, with or without spermicide, different sizes, shapes, textures, and so on.

The three main materials for condoms – latex, polyurethane and lambskin – all help prevent pregnancy. However lambskin does not protect against sexually transmissible infections (STI). Condoms can be used for oral sex, with toys, and as an extra barrier method for STI protection even when not having penetrative sex.

Specific directions for using condoms are included with the package. Read them carefully and follow them. One extra hint they don’t tell you is to put a drop of lubrication in the tip of the condom before you roll it on. This eases application, decreases the risk of air pockets that can cause condoms to break, and feels more pleasurable to many men.

EFFECTIVENESS: Used correctly, male condoms offer up to 98% effectiveness against pregnancy. With typical use, male condoms are about 85% effective against pregnancy. The female condom is about 95% effective at preventing pregnancy when used correctly, and about 79% effective with typical use. Condoms also offer a reduced risk of some STIs such as chlaymida, gonorrhea and HIV; others (like herpes, HPV and syphilis) can still be transmitted even if a condom is used correctly).

SIDE EFFECTS: There are no long term side effects with condom use. If you are allergic to latex, you can use polyurethane or organic condoms instead. If you are sensitive or allergic to the lubricants used with many condoms, you can use an un-lubricated condom and add your own lubricant to it (some lubricants such as Just Like Me by pureromance.com or Pink or Sliquid, available at condomania.com have been formulated to reduce the risk of irritation).

BENEFITS: Condoms are a non-hormonal method of birth control that can be used only when necessary. Both partners can buy and carry condoms, and condoms prevent against most STIs.

Beyond their use for contraception and STI prevention, condoms have all sorts of advantages. Some condom designs are just plain fun and can add some extra spice into the moment. Condoms come in different colors, patterns, flavors and some even glow in the dark. With mentholated and warming condoms, they can add that extra bit of sensation, or work to help control climax. Condoms help many men have longer lasting sex.

They can also make cleanup after sex easier, and changing condoms between anal and vaginal sex can help prevent UTIs.

COST: Condoms can cost from 50 cents to $4 a piece, depending on what kind you get. Your local health center or STI testing facility might even have them for free.

For more on male and female condoms, see our Condoms and Dental Dams Resource Page.

Diaphragms

USE: Diaphragms are flexible, latex, dome-shaped cups with a bendable rim designed to fit securely in the vagina to cover the cervix.

Diaphragms are sized to fit individual women. A gynecologist measures the cervix and orders one in the correct size.

To use a diaphragm, the woman fills it with spermicide and inserts it up to before sexual intercourse. The diaphragm should then remain in place for 6-8hrs after the last ejaculation. A diaphragm can be left in place for up to 24 hours, but adding additional spermicide before repeated intercourse is recommended.

EFFECTIVENESS: 94% effective with perfect use, 82% effective with typical use. Improper fitting, removing it too soon after sex or deterioration of the diaphragm by oil-based lubricants can hinder effectiveness.

SIDE EFFECTS: Allergic reaction to latex (silicone ones are available), bladder infection, or vaginal soreness from the pressure of the rim, and, in a few women, Toxic Shock Syndrome. Many women are allergic or sensitive to spermicide. Diaphragms also don’t offer any protection against STIs. There is also an increased risk of frequent urinary tract infections in some women. Diaphragms also need to be inserted before intercourse, requiring some planning, or decreasing momentary spontaneity.

BENEFITS: Non-hormonal method of birth control that can be used only when necessary. Many partners report not being able to feel the diaphragm when in place, and the diaphragm can be put in up to 18 hours ahead of time and reinserted with cleaning every 24 hours. This allows for a feeling of spontaneity during intercourse.

COST: The diaphragm itself will be about $15-$75 (depending on where get one), and the total cost may also include the cost of the doctor’s visit and you buy spermicide to use with it.

Contraceptive Sponge

USE: A contraceptive sponge is made of plastic foam and contains spermicide. It is soft, round, and about two inches in diameter. It has a nylon loop attached to the bottom for removal. It is inserted deep into the vagina before intercourse. The Today Sponge is the only brand of contraceptive sponge available in the United States today. Contraceptive sponges should not be used if you are allergic to sulfa drugs, polyurethane or spermicide.

EFFECTIVENESS: 91% effective with perfect use, 84% effective with typical use. Effectiveness decreases if women using the sponge have given birth. Male partners can help effectiveness by wearing a condom or pulling out before ejaculation.

SIDE EFFECTS: Sponges should not be used if there is any kind of vaginal bleeding (including menstruation), as it can increase your risk for Toxic Shock Syndrome. The sponge contains spermicide, which many women are allergic or sensitive to. It can cause vaginal irritation or make sex too messy or too dry, which using a water based lubricant may help with. Sponges have expiration dates and can expire.

BENEFITS: A disposable, non-hormonal method of birth control that can be used only when necessary. Women and most men report not being able to feel the sponge once in place. No prescription necessary. Is immediately effective and remains effective for 24hrs. Does not need to be changed between intercourse (during the same 24hrs).

COST: A package of three sponges costs $14 and can be purchased over the counter at most drugstores. The costs may be slightly lower or higher depending on where you live.

Cervical Caps

USE: The cervical cap is a soft rubber barrier, smaller than a diaphragm, that covers the cervix in order to prevent sperm from entering into the uterus.

Like the diaphragm, a cervical cap is fitted to a woman’s body. A cervical cap is also used in with spermicide and inserted into the vagina to cover the cervix before sex. There are also disposable caps.

To use a cap, the woman fills it with spermicide and inserts it up to before sexual intercourse. The cap should then remain in place for 6-8hrs after the last ejaculation. A cap can be left in place for up to 48 hours, but adding additional spermicide before repeated intercourse is recommended.

EFFECTIVENESS: With perfect use, the cap is 91% effective, and with typical use, it is 82% effective. Removing it too early, erosion by oil-based lubes and incorrect insertion can inhibit effectiveness. It can also be knocked out of place during intercourse.

SIDE EFFECTS: Allergic reaction to the latex, infection, and, in some women, TSS. The cervical cap also doesn’t offer any protection against STIs. Many women are allergic or sensitive to spermicide. Cervical caps also need to be inserted before intercourse, requiring some planning.

BENEFITS: Non-hormonal method of birth control that can be used only when necessary. Many partners report not being able to feel the cervical cap when in place. Requires less spermicide than the diaphragm. It can be put in up to 48 hours ahead of time. This allows for a feeling of spontaneity during intercourse. Small and discreet to carry.

COST: The cervical cap itself costs about $30 and it can last for up to two years. Other costs may include paying for the doctor’s appointment(s) and the spermicide that is used with it.

Hormonal Methods

The Pill/Birth Control/Oral Contraceptives

USE: Birth control comes in two types – combination (contain two hormones – estrogen and progestin) or progestin-only pills.

While both hormones prevent ovulation, estrogen predominantly keeps a woman’s ovaries from releasing eggs, while progestin predominantly prevents pregnancy through secondary methods such as thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. Birth control is obtained though a prescription from a healthcare provider, and pills are taken once a day (ideally at the same time each day).

Different varieties of hormonal birth control have different balances of estrogen and progestin. Some pills vary dosage throughout a woman’s cycle, and some pills balance the hormones differently. This is why women may experience side effects very differently for different types of hormonal birth control, and even different brands of birth control pills. For many women, finding the right hormonal birth control is a process of trying different types.

Stacking is a method where women stay continuously on hormonal birth control to not menstruate. Many studies show regular menstruation to not be necessary, and taking birth control without the placebo week, or skipping the week off, allows for women to avoid menstruation or experience much lighter periods. It is possible to just skip one placebo week in order to miss an inconvenient period, or for many women on hormonal birth control to go several months without menstruating.

EFFECTIVENESS: With perfect use, 99.9% effective with “combination pill” (estrogen and progestin), and 99.5% effective with progestin only pills. With typical use, the pill is about 92% effective. Some medications can make the pill less effective: certain anti-HIV protease inhibitors, certain anti-seizure medications, a particular anti-fungal medication, griseofulvin (Fulvicin, Gris-PEG, Grifulvin V, Grisactin, and Gristatin), and rifampin (type of antibiotic).

SIDE EFFECTS: Irregular bleeding, particularly with missed pills, weight gain, weight loss, breast tenderness, acne, nausea, headaches, changes in vaginal lubrication, changes in sex drive, mood changes including depression, and gastrointestinal disorders.

Side effects often subside after the first few cycles, and they vary greatly from woman to woman and brand to brand. Rare but more serious side effects include blood clots, stroke or heart attacks and are increased with tobacco use. Women who use hormonal methods of birth control (such as the Pill, Patch, Depo Provera or Lunelle) are strongly advised not to smoke.

The pill also doesn’t offer any protection against STIs.

BENEFITS: The pill provides long term protection and allows for a level of spontaneity to intercourse (with long term partners, and others tested for STIs). For many women hormonal birth control methods can help with menstrual problems, to stabilize mood, skin conditions, and other hormonal problems. Women on the pill can also stack, avoiding menstruation.

COST: It varies by brand, but cost can range from about $15-$50 a month. Other costs may include paying for the doctor’s appointment(s). Insurance may often cover some types of hormonal birth control.

The Patch (Ortho-Evra)

USE: The birth control patch is a thin, beige, plastic patch that sticks to the skin. Ortho-Evra is obtained though a prescription from a healthcare provider. Wear a patch for a week, then another patch for the 2nd week, then a third patch for the 3rd week and then go “patch-free” the fourth week. The hormones are delivered through the skin and into the bloodstream.

EFFECTIVENESS: The Patch is believed to be as effective as the Pill (99% effective with perfect use; 92% with typical use). Like the Pill, it works by preventing ovulation (the release of an egg). It also causes changes to a woman’s cervical mucus, making it more difficult for a man’s sperm to enter into the uterus.

SIDE EFFECTS: Potential side effects include “breast symptoms, headache, application site reaction, nausea, upper respiratory infection, menstrual cramps and abdominal pain” according to Othro-Evra’s website. Like the Pill, rare but more serious side effects include blood clots, stroke or heart attacks and are increased if you smoke tabaccos. Women who use hormonal methods of birth control (such as the Pill, Patch, Depo Provera or Lunelle) are strongly advised not use tobacco products. The patch also doesn’t offer any protection against STIs.

BENEFITS: The patch allows for women to not have to worry about taking a pill every day, and is instead, a form of birth control that is used on a weekly basis. Like the pill, the patch can be used for stacking to avoid menstruation. The patch may also have the benefits of other methods of hormonal birth control.

COST: The price is about the same as the Pill, at around $15-$50 a month. Other costs may include paying for the doctor’s appointment(s).

Birth Control Shot (Depo-Provera)

USE: The birth control shot is an injection of a hormone that prevents pregnancy. Injection is typically in the buttocks but sometimes in the arm, every 13 weeks (three months). Shot must be administered by a medically trained person at a medical facility.

EFFECTIVENESS: 99.7% effective. Effectiveness is only reduced if women don’t get the shot on time. If the birth control shot is given within the first seven days after the start of a woman’s period or within five days after miscarriage or an abortion, pregnancy protection is effective immediately. Otherwise, a backup birth control should be used – like a condom, female condom, diaphragm, – for the first week after getting the shot.

SIDE EFFECTS: The shot uses the highest dose of hormones of any hormonal birth control, causing the highest risk of side effects.

All of the side effects of the pill may apply. Some women gain weight, some have irregular, excessive, or painful menstruation. Other women report having no period at all. Decreased sex drive can occur in some women. It also doesn’t offer any protection against STIs. Depo Provera has been associated with loss of bone density which may contribute to osteoporosis; discontinuing the use of Depo Provera does not reverse the loss of bone density.

BENEFITS: The shot allows women to only deal with birth control every three months.

COST: If an exam is required, it may cost about $35 to $250. Each injection costs between $35 and $75, and each visit after the initial exam may cost between $20 and $40. If you are more than two weeks late for your injection, a pregnancy test may be needed before another shot can be administered. Pregnancy tests cost about $20.

Birth Control Implant (Implanon)

USE: Birth control implants are small rubber (matchstick-size) implants which release a slow, steady stream of hormones are placed just below the skin of the arm. They required a prescription from a healthcare provider, and a procedure to implant them. Implants are left in for 3 years and then must be removed. Removal may require an outpatient surgical procedure with associated risks.

EFFECTIVENESS: 99.01% effective and extremely reliable because, unlike the pill, there is nothing the user can forget, or do incorrectly. Implanon is effective for 3 years at a time.

SIDE EFFECTS: Sometimes the implants are slightly visible. They also don’t offer any protection against STIs. 20% of women using the implant stop having periods and they can be used during breast feeding. There can be complications at the site of the implant, so a medical provider should be consulted if there are any concerns or if the implant site is red, irritated or bleeding.

BENEFITS: Implants allow women to not have to worry about birth control for three years at a time. Over time, this is one of the least expensive methods of birth control.

COST: The cost of the exam, Implanon, and insertion ranges from $400-$800 at Planned Parenthood. Removal costs between $75 and $150. The total cost pays for pregnancy protection that can last for three years.

Birth Control Vaginal Ring (NuvaRing)

USE: The vaginal ring (brand name NuvaRing) is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month. This type of birth control requires a prescription from a healthcare provider. This method works by releasing hormones (a combination of estrogen and progestin) into a woman’s body to be absorbed through the vaginal wall and stopping ovulation (the release of an egg) from occurring.

EFFECTIVENESS: NuvaRing is thought to be as effectiveness and the Pill when used correctly (about 99% effective when used perfectly, 92% effective with typical use).

SIDE EFFECTS: Potential side effects (usually in the first 2-3 months of use) include increased vaginal discharge, vaginal irritation, or infection, bleeding between periods, breast tenderness, and nausea. Like other hormonal methods of birth control, rare but more serious potential risks include blood clots, heart attacks and strokes, high blood pressure and heart disease, breast cancer, liver tumors and gallbladder disease. Women who use hormonal contraceptives are typically strongly advised not to use tobacco products. It also doesn’t offer any protection against STIs.

BENEFITS: NuvaRing allows for women to not have to worry about taking a pill every day. NuvaRing can easily be used for stacking to avoid menstruation. It may also have the benefits of other methods of hormonal birth control. NuvaRing also provides the lowest hormone dose out of hormonal birth controls, decreasing side effects. This is possible because the vaginal walls are highly absorptive, and it can continuously release hormones. NuvaRing can also be taken out for up to 3 hours, or left in for intercourse. Most partners and almost all women report not being able to feel NuvaRing.

COST: With insurance, the vaginal ring is about the same cost as the Pill, around $15 – $50 per month. Without insurance, NuvaRing is a slightly more expensive method. Other costs may include paying for the doctor’s appointment(s).

Behavioral Methods

Abstinence

USE: Abstinence has different meanings for different people. Socially, abstinence is something that the individual can define and identify with for many different reasons. As a birth control method, “contraceptive abstinence” means not having penis in vagina (PIV) sex, while complete abstinence for the prevention of STIs should include not having vaginal, anal or oral sex. Abstinence can be used for any length of time, and can be practiced between other methods of birth control.

EFFECTIVENESS: Abstinence is the only absolutely certain contraceptive method if practiced correctly and consistently.

SIDE EFFECTS: None. It is important to communicate with your sexual partner(s) about your choice to be abstinent and what you mean by abstinence to ensure that you and your partner are aware of your sexual boundaries (what sexual behaviors you are willing to do). If you are having genital contact with a partner (e.g. oral sex, anal sex, rubbing genitals together), then you are still at risk for STIs.

BENEFITS: Abstinence can help bring couples closer together, or allow for individuals to focus on other parts of their life. Abstinence can be practiced for as much or as little time as the person would like.
COST: Free.

Natural Family Planning (NFP) or Fertility Awareness Methods (FAMs)

USE: There are a variety of NFP or FAM methods available (temperature method, cervical mucus method, calendar method, cycle beads); some use a combination of these.

EFFECTIVENESS: FAMs work by keeping sperm out of the female reproductive tract in the days near ovulation, when a woman is most fertile – most likely to become pregnant. During fertile times in the woman’s cycle she can either abstain from sex, or use a backup method such as condoms. Done correctly, this method is 97% effective. With typical use, it has been estimated to be about 75%-88% effective at preventing pregnancy. This method may not work for women with irregular periods or if you have an STI or frequent abnormal vaginal discharges.

SIDE EFFECTS: Relationship stress is possible. This method requires open, honest communication between partners and a strong commitment to follow the schedule. It also doesn’t offer any protection against STIs. This method also requires the woman or couple to be incredibly organized and reliable about tracking her cycle.

BENEFITS: This is a non-hormonal method that does not require any additional barrier methods to be used. NFP allows for a woman to better understand her body and natural cycle, making this an informative experience for a lot of women.

COST: The method itself is free. A NFP thermometer can cost upwards of $100; it offers considerable certainty and can be worth the investment to couples willing to invest the time and effort necessary to use it correctly. A healthcare provider, especially those at a family planning clinic, can provide more information and/or detailed instructions on using NFP methods.

Withdrawal/Pull Out Method

USE: The man withdraws the penis from the woman’s vagina before he ejaculates, thus minimizing the amount of sperm launched into the cervix. Because sperm may be present on the head of the penis or in the urethra, it may be transported to the vagina via pre-ejaculate. This method requires excellent ejaculatory control in the male partner, and typically calls for excellent communication skills in the couple.

EFFECTIVENESS: Theoretical effectiveness is 94% and typical use effectiveness is 81%. Even if a man pulls out in time, pregnancy can still occur. Some experts believe that pre-ejaculate, or pre-cum, can pick up enough sperm left in the urethra from a previous ejaculation to cause pregnancy. Recent information from the Guttmacher Institute supports this method as an effective birth control method, especially for those who cannot use hormonal forms of contraception, but reiterate that it does not protect against STIs.

SIDE EFFECTS: Planning on this method may leave you unprepared to use another method (like a condom) but is better than no behavioral methods at all. Withdrawal does not offer any protection against STIs.

BENEFITS: This is a non-hormonal method that does not require any additional barrier methods to be used. Withdrawal also works as a good backup method when paired with other types of contraception for increased effectiveness.

COST: Free.

Other Contraceptive Options

Intrauterine Devices (IUDs)

USE: IUDs are small, “T-shaped” devices made of flexible plastic. A health care provider inserts an IUD into a woman’s uterus to prevent pregnancy. There are two brands of IUD available in the United States – ParaGard and Mirena. The ParaGard IUD contains copper. It is effective for 12 years. The Mirena IUD releases a small amount of progestin, a hormone. It is effective for five years.

EFFECTIVENESS: IUDs are 99% effective in pregnancy prevention and one of the most effective forms of birth control. The ParaGard IUD can be used as emergency birth control, to prevent pregnancy after unprotected intercourse. It can reduce the risk of pregnancy by 99.9 percent if inserted within 120 hours (five days) after unprotected intercourse. IUDs do not protect against STIs.

SIDE EFFECTS: ParaGard (non-hormonal) has no typical hormonal side effects but it can increase your menstrual flow and cramps and spotting between periods. Mirena (hormonal) may reduce period flow and cramps. Serious side effects are rare but can include an IUD slipping out of the uterus which then must be removed and replaced to prevent pregnancy. Other rare side effects might include infection or having an IUD burse or push through the uterine wall. IUDs also do not prevent against, and increase the risk of ectopic pregnancies.

BENEFITS: The IUD can be effective for up to 12yrs, providing a long term reversible birth control method, where women do not have to worry about their contraception on a daily or monthly basis. The IUD is also the least expensive method over time, and does not have many of the negative side effects of hormonal birth controls.

COST: The IUD is the least expensive long-term and reversible form of birth control available. The cost for the medical exam, the ParaGard or Mirena IUD, the insertion of the IUD, and follow-up visits to your health care provider can range from $175 to $500. That cost pays for protection that can last from 5 to 12 years. Medicaid and private health insurance may cover the cost of the ParaGard or Mirena IUD. Family planning clinics usually charge less than private health care providers.

Emergency Contraception/”Morning After Pill”

USE: Emergency Contraception (EC) or “Plan B” is a hormonal contraceptive pill combination that can be used to prevent pregnancy up to five days after unprotected sex, but is more effective the sooner it is taken. The first dose is taken within 72 hours of unprotected intercourse, and the second dose is taken 12 hours later. Emergency contraception is not abortion. According to the FDA, “Emergency contraceptive pills are not effective if the woman is pregnant; they act by delaying or inhibiting ovulation, and/or altering tubal transport of sperm and/or ova (thereby inhibiting fertilization), and/or altering the endometrium (thereby inhibiting implantation).”

EFFECTIVENESS: Plan B reduces the risk of pregnancy by 89 percent when started within 72 hours (3 days) after unprotected intercourse. Only 1 out of 100 women will become pregnant after taking Plan B if started within three days. Emergency contraception can be started up to 120 hours (5 days) after unprotected intercourse. The sooner it is started, the better.

SIDE EFFECTS: Progestin-only contraception, such as the one offered at Planned Parenthood, has a much lower incidence of side effects – nausea 23% and vomiting 5%, and other side effects such as dizziness, headache, fatigue and cramping between 11-20%. Although, EC delivers a high dose of hormones, and can temporally cause mood changes and spotting or abnormal bleeding.

BENEFITS: EC can be taken following unprotected intercourse, and in the case of a birth control failure. Both men and women can purchase EC. As EC does not quickly expire, women can buy an emergency pill to have on hand “just in case”.

COST: The cost of emergency contraception varies a great deal, depending on where you go and what services you need. Plan B may cost anywhere from $10 to $45, and availability varies from state to state. Pharmacists may also refuse to sell EC, making it difficult to get in some areas. If you are not 18 and need a prescription, the health care visit may cost anywhere from $35 to $250, depending on where you live, although it is possible to have an older friend, relative, or partner purchase the pill.

Sterilization/Vasectomy

USE: Sterilization is a form of birth control. One type of sterilization for women commonly referred to is tubal ligation. All sterilization procedures are meant to be permanent. During a sterilization procedure, a health care provider closes or blocks a woman’s fallopian tubes. There are a few different types of sterilization for women, learn more here.

Vasectomies in men are also meant to be permanent and involve closing or blocking the tubes that carry sperm. When the tubes are closed, sperm cannot leave a man’s body and cause pregnancy.

EFFECTIVENESS: Sterilization is nearly 100 percent effective in women. Most kinds of sterilization for women are effective right away. But it takes about three months before Essure (the coil method) is effective.

Vasectomy is the most effective birth control for men. It is nearly 100 percent effective. However, vasectomy is not immediately effective. Sperm remains beyond the blocked tubes. You must use other birth control until the sperm are used up, which usually takes about three months.

Neither form of sterilization prevents STIs.

SIDE EFFECTS: Most women can be sterilized safely. But like any medical procedure, there are risks. One possible (rare) risk is that the tubes may reconnect by themselves. When women get pregnant after being sterilized, about 1 out of 3 has a pregnancy that develops in a fallopian tube. This is called ectopic pregnancy. Ectopic pregnancy is serious and may be life threatening.

There are different ways for men to be sterilized. One type does not require an incision – a cut. The other types of vasectomy require an incision. Incision methods take about 20 minutes. The no-incision method takes less time. Major complications with vasectomy are rare and are usually caused by infection.

BENEFITS: Sterilization is a permanent form of contraception, allowing individuals or couples who do not want further children to not worry about birth control.

COST: For women, the cost of sterilization ranges from $1,500 to $6,000. (The cost of vasectomy is much less.) Some clinics and doctors adjust fees on a sliding scale according to income. If you need to have your procedure in a hospital, it may be more expensive. About 1 out of 2 sterilizations are performed shortly after childbirth or abortion but you need to make arrangements with your health care provider in advance if you want to combine sterilization with other procedures.

A vasectomy can be performed in a medical office, hospital, or clinic. Nationwide, the cost of a vasectomy ranges from $350-$1,000, including the follow-up sperm count. (Sterilization for women costs up to six times as much.) Some clinics and doctors use a sliding scale according to income.

There may be state or federal requirements for sterilization, such as age restrictions or waiting periods. Ask if there are any restrictions when you make an appointment.

Spermicides

USE: Spermicide contains chemicals that both kill sperm, and prevent it from further moving up the female reproductive tract. Spermicide is available in different forms, including creams, film, foams, gels, and suppositories. Spermicide can be used alone, or it can be used with other birth control methods to make them more effective. It should always be used with the diaphragm and cervical cap.

EFFECTIVENESS: When used perfectly spermicide is 85% effective, and 71% with typical use. Spermicide is considered better effective when used female condom or other device like a diaphragm or cervical cap. A male partner can make spermicide more effective by using a latex condom or pulling out before ejaculation.

SIDE EFFECTS: Some women complain that spermicides are messy or that they leak from their vaginas. Spermicide may also irritate the penis or vagina. Switching brands may solve this problem. The most commonly used spermicide in the U.S. contains nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or if it is used by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections. Many women are allergic to spermicides. Spermicide can also expire.

BENEFITS: Spermicide is available over the counter, and serves as an excellent non-hormonal backup method with other forms of birth control.

COST: Spermicide is available at local family planning clinics, drugstores, and some supermarkets. Applicator kits for foam and gel cost about $8. Refills cost $4-$8. Large cans of foam contain between 20 and 40 applications. Film and suppositories are also about $8.

Vaginal Contraceptive Film (VCF)

USE: VCF is a thin film that melts into a spermicidal gel covering the cervix. VCF is most effective 15 min after it is applied, and then remains effective for three hours.

EFFECTIVENESS: When used perfectly 82%-94% which lowers to 71% with typical use. VCF increases effectiveness when used with another method of birth control.

SIDE EFFECTS: Like other types of spermicide, some women experience irritation or allergic reactions from VCF.

BENEFITS: VCF is a non-hormonal method. Unlike other spermicides, VCF melts into a non-runny gel. VCF can also be purchased over the counter.

COST: VCF costs about $13 and can be purchased at most pharmacies or online.

Pregnancy Options

Millions of women face unplanned pregnancies every year. In fact, half of all pregnancies in the United States are unplanned. If you think you may be pregnant, the first step is to take a pregnancy test. Over the counter pregnancy tests are 99% accurate if used after a missed period, but may show a false negative if used too soon. Women whose home pregnancy tests show they are pregnant often go to a health care provider to have the results confirmed.

If you are pregnant, you have three main options to think about – abortion, adoption, and parenting.

For more information, read about the benefits and risks of each option at The American Pregnancy Association website. Think about which benefits and risks are most important to you.*

Abortion

USE: Abortion is a safe and legal way for women to choose to end pregnancy. Over 30% of American women have an abortion during their lifetime There are two kinds of abortion in the U.S.: in-clinic abortion and the abortion pill.

• In-Clinic: The most common in-clinic procedure is called aspiration or vacuum aspiration. Aspiration is usually used up to 16 weeks after a woman’s last period. More than 9 out of 10 abortions in the United States happen during this time. D&E (dilation and evacuation) is another kind of in-clinic abortion. D&E is usually performed later than 16 weeks after a woman’s last period. Less than 1 out of 10 abortions in the United States happen during this time. After 24 weeks of pregnancy, abortions are performed only for serious health reasons. These procedures are often quick to perform, with early abortions regularly taking under 15 minutes.
• Abortion Pill: The name for “the abortion pill” is mifepristone. It was called RU-486 when it was being developed and is 97% effective. This method allows a woman to experience the abortion in the comfort of her own home, but may last longer or be more painful than an in-clinic procedure. Like an in-clinic abortion, a follow up with a health care provider is needed after an abortion to ensure the pregnancy is ended and there were no complications. Some of the medicines used in medication abortion may cause serious birth defects if the pregnancy continues. So, in the unlikely case that it doesn’t work, an aspiration abortion is needed to end the pregnancy.

EFFECTIVENESS: These abortion methods are safe and work almost all the time. A follow up exam with a health care provider will make sure it worked and there are no complications.

SIDE EFFECTS: Some bleeding after an abortion is normal. A women may pass a few clots about the size of a quarter. It’s normal to have spotting that lasts up to six weeks, heavy bleeding for a few days or bleeding that stops and starts again. During this time, it’s OK to use pads or tampons, but using pads makes it easier to keep track of your bleeding. It’s also normal to have no bleeding after an abortion.

Serious complications from abortions are rare but have warning signs. These might include: very heavy bleeding (if you pass clots larger than a lemon or soak through more than two maxi pads an hour, for two hours or more in a row), pain or discomfort (not helped by medication, rest, a hot water bottle, or a heating pad), a fever, vomiting for more than 4-6 hours, an unpleasant, smelly discharge from your vagina, or signs that the person is still pregnant.

The abortion pill also has rare risks of allergic reaction, incomplete abortion, infection, undetected ectopic pregnancy, or very heavy bleeding. Signs of serious complications are similar to that of an in-clinic abortion and medical care should be sought if any of these symptoms are present.

Despite much propaganda, safe and legal abortions have very low risk, and far fewer side effects than childbirth.

Choosing to have an abortion can be a very emotional decision and women may have a wide range of feelings after an abortion. Some women feel anger, regret, guilt, or sadness for a little while. Serious, long-term emotional problems after abortion are about as uncommon as they are after giving birth. A health care (or abortion) provider can provide resources about how to deal with post-abortion emotional issues.

You can also get more information about post-abortion issues here.

COST: The cost at health centers ranges from about $350 to $900 for abortion in the first trimester. The cost is usually more for a second-trimester abortion. Costs vary depending on how long you’ve been pregnant and where you go and optional pain medication or sedation. Hospitals generally cost more than family planning centers like Planned Parenthood. The laws and availability of abortions vary from state to state. Parental or judicial consent may be needed for women under 18 in some states.

Adoption

Adoption is the act of carrying a pregnancy to term and then letting someone else raise your child. If you are facing an unplanned pregnancy, and do not want to have an abortion or be a parent, adoption might be right for you. It is a permanent, legal agreement in which you agree to place your child in the care of another person or family.

Here are some things to ask yourself if you are considering adoption:

• Am I ready to be a parent?
• Can I afford to be a parent now?
• Can I accept not being my child’s primary parent?
• Is someone pressuring me to choose adoption?
• Am I prepared to go through pregnancy and childbirth?
• Will I be able to cope with the feeling of loss that I may have?
• Do I have people in my life who will help me through the pregnancy and adoption process?
• How important is it to me what other people will think about my decision?

You may want to discuss your answers with your partner, someone in your family, a friend, a trusted religious adviser, or a counselor.

There are two types of adoption – “open” and “closed.”

• Open adoptions can involve contact between the birth parent(s) and the adopting family. This can sometimes mean that the birth parent(s) have a choice in who adopts their child based on the family’s values, lifestyle, and religion. It can also include contact after the child is adopted; ongoing visits with the child, phone calls, or pictures.
• Closed adoptions, or confidential adoptions, happen when the birth mother and adopting family do not have any information about one another. Women may choose a closed adoption in order to have more privacy.

The laws about birth fathers are different from state to state, so talk with an adoption counselor or lawyer about what rights a birth father has in your state. You may need his consent in order to plan an adoption.

For more information on adoption, see the Child Welfare Information Gateway website.

Parenting

What to do about an unplanned pregnancy is an important and common decision faced by women. If you’re trying to decide if parenting is the right option for you, you may find it helpful to list the advantages and disadvantages of having a child.

Here are some questions you might ask yourself if you’re considering keeping and parenting a child

• Am I ready to help a child feel wanted and loved?
• Am I ready to cope with a tighter budget, less time for myself, and more stress?
• Do I have the support of family and friends?
• Am I ready to accept responsibility for all my child’s needs?
• Would I prefer to have a child at another time?
• Is anyone pressuring me to continue or end the pregnancy?
• Can I afford to have a child?
• What would it mean for my future and my family’s future if I had a child now?
• How important is it to me what other people will think about my decision?
• Can I handle the experience of pregnancy and raising a child?

Think about what your answers mean to you. You may want to discuss your answers with your partner, someone in your family, a friend, a trusted religious adviser, or a counselor.

Whether you choose adoption or to become a parent, if there is a chance that you will continue the pregnancy, prenatal care should begin as soon as possible. A medical exam early in your pregnancy – and regularly throughout your pregnancy – make sure that you are healthy and the pregnancy is normal.

Even though most women have safe and healthy pregnancies, there are certain risks of pregnancy for a woman. They range from discomforts, such as nausea, fatigue, and aches and pains, to more serious risks, such as blood clots, high blood pressure, and diabetes. In extremely rare cases, complications can be fatal. That’s why early and regular prenatal care is very important.

It may be important to take your time and think carefully about your decision. But you may not want to wait too long. If you are considering abortion, you should know that abortion is very safe, but the risks increase the longer a pregnancy goes on.

Sex Research & Sex Therapy